A brief history of telemedicine

In 1998 the World Health Organization defined Telemedicine as the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities. Many people believe that telemedicine is a relatively new phenomenon that has only been around the last ten years. In fact, telemedicine has existed in one form or another for over thirty years. As early as 1960 the National Aeronautics and Space Administration also known as NASA, was using telemedicine applications in the space program. The early space suites contained monitoring devices that transmitted information regarding the astronauts to mission control from space. NASA's research in telemedicine as it related to astronauts in space provided much of the early research that laid the foundation for our modern telemedicine program. There were at least fifteen telemedicine projects conducted during this period.

Telemedicine's past is closely tied to the United States space program. Its future will be tied to Electronic Health Records. One of President Obama's goals as president is to implement a nationwide system of electronic health records by the year 2014. It is his hope that implementing his plan will increase the quality of health care while decreasing its cost. To further this goal on February 12, 2010, the Obama administration announced that they would award nearly '$1 billion in grants to help states and health care providers implement health IT systems" (Obama Administration To Award Nearly $1B in Health IT Grants, 2010). The grants primary aim is to extend health IT access to more than 100,000 hospitals and primary care physicians by 2014.

Telemedicine applications are currently being used in many medical specialties. However, they have been especially effective in the following areas: the treatment of underserved rural populations, incarcerated prisoners, and the identification, and treatment of epidemic and pandemic disease. Traditionally, patients who lived in rural communities have had difficulty in obtaining quality medical care. This has occurred for three reasons. The first reason is the lack of quality physicians who are willing to work in remote rural areas. The second reason is the lack of diagnostic equipment and quality medical facilities available in these areas and finally the distance and cost that patients would incur when trying to obtain medical care.

Technology such as telespirometry, arrhythmia monitors, fetal monitors, blood pressure devices and glucose monitors have helped to create a medical home network. A medical home network is "administered by primary care physicians and linked to specialists, hospitals, and information centers by a satellite based telemedicine network" (Graziplene, 2009). This technology has made it possible for doctors across the country or in some cases across the world to monitor patients and assist local doctors with diagnosis and plan of care. This has resulted in improved health outcomes and lower medical cost for these patients.

In addition to rural areas, telemedicine has been very successful in treating patients incarcerated in prisons. Prison systems around the country have been using telemedicine to treat inmates for over a decade. The use of telemedicine has been particularly successful in reducing the amount of times that prisoners were transported outside of the jail to see specialists. An article posted by the National Institutes of Justice's website stated that during the 11 months prior to a jail in Leesburg Pennsylvania implementation of a telemedicine program: "inmates were taken out of the prison 419 times to meet with local specialists, either in their offices or in a community hospital" (Telemedicine Reduced External Visits to Specialists , 1999). During the period being studied, Telemedicine averted about 35 trips for inmates to see local specialists outside prison walls, for a savings of approximately $27,500. If this figure was adjusted for 2010, the savings would be much greater. (Telemedicine Reduced External Visits to Specialists , 1999)

Cost savings are only one positive that associated with the use of telemedicine in the treatment of prisoners. Chief among the other positives are the reduction of safety issues associated with transporting patients outside of the prison as well as ensuring the safety of visiting specialists while they are in the prison. In addition to cost savings, remote telemedical consultations can provide access to new specialists and improve the quality of care delivered to prison populations making it a win-win situation for everyone involved.

Finally, diagnosing, treatment, and prevention of epidemic and pandemic situations have been a difficult and costly prospect. A report funded by the CDC and the HHS Assistant Secretary for Preparedness and Response highlighted the need for home health care during pandemic situations, in particular influenza. Telemedicine is a critical part of this treatment. The report suggested that remote vital sign monitoring units using standard phone lines should be available to patients. In addition to remote vital sign monitoring units, an interactive voice response system should be employed to enable callers to use their touchtone phones to receive information automatically (Report Offers Resources for Home Health Care Response During a Flu Pandemic , 2008).

Another important component in the treatment of epidemic and pandemics is the national electronic disease surveillance system (NEDSS). The goal of this system is to create the ability to transfer "public health, laboratory and clinical data over the internet" (Burke & Weill, 2009 (pg 95). This technology will allow data related to pandemic and epidemics to be collected and eventually transferred to agencies like the CDC in real time. This will result in quicker identification and treatment of the underlying diseases that cause the pandemic to begin with.

It is certain that telemedicine will play an important role in the future of healthcare; however, this technology is not problem free. There are social, legal, and ethical issues associated with its use. These issues include the responsibilities and potential liabilities associated with the use of telemedicine. For example if an error is made during telemedicine who is responsible? Is the prescribing doctor, the consulting doctor, the radiologist, or the technician who transmits the information responsible for the error?

However, the biggest problems are related to maintaining patient confidentiality and protecting patient records. If a patient's health information is transmitted across county, state, or international lines, is it possible to guarantee its confidentiality. The solutions that have been discussed are encryption and creating id numbers instead of using patient names on documents. Unfortunately, there are also societal implications associated with the creation of technology that will lessen and possibly eliminate face-to-face contact between doctors and patients as well as financial issues related to physician reimbursement for care provided using telemedicine services.

These issues will need to be resolved before telemedicine can be used on an international scale. Fortunately, the advantages far outweigh the negatives and telemedicine will be the future of health care. Although most people believe, that telemedicine is relatively new it has been around since the 1960's and the United States space program. Telemedicine's past was tied to the space program and its future will be tied to President's Obama's plan to require the use of Electronic Health Records. Although telemedicine has many possible applications, it has proven the most successful in three areas. These are healthcare in rural populations, treatment of incarcerated prison inmates, and in the prevention and control of epidemics and pandemics. Telemedicine's future is guaranteed. However, there are legal, social, and ethical issues that will need to be resolved before it can become commonplace. The biggest issue to be resolved is how to protect patient confidentiality. There are potential solutions such as encrypting patient files, assigning ID numbers instead of names, and limiting access to these files. However, even with its problems, telemedicine provides a possible solution to America's healthcare woes and will therefore be a growing part of America's healthcare system in the future.

References

  • Brown, N. (1995, May 30). A Brief History of Telemedicine. Retrieved March 8, 2010, from tie.telemed.org: http://tie.telemed.org/articles/article.asp?path=articles&article=tmhistory_nb_tie95.xml
  • Graziplene, L. R. (2009). Creating T lemedicine-Based Medical Networks for Rural and Frontier Areas. Retrieved March 10, 2010, from businessofgovernment.org: http://www.businessofgovernment.org/pdfs/GrazipleneExecSumm.pdf
  • Obama Administration To Award Nearly $1B in Health IT Grants. (2010, February 12). Retrieved March 9, 2010, from ihealthbeat.org: http://www.ihealthbeat.org/articles/2010/2/12/obama-administration-to-award-nearly-1b-in-health-i2009).
  • Remote monitoring devices. In Burke/Weill, Information Technology for Health Professionals (p. 65). New Jersey: Pearson Prentice Hall. t-grants.aspx
  • Report Offers Resources for Home Health Care Response During a Flu Pandemic . (2008, July 8). Retrieved 13 2010, March, from www.ahrq.gov: http://www.ahrq.gov/news/press/pr2008/hhcflupr.htm
  • Telehealth 'to take off by 2012'. (2010, January 28). Retrieved March 2010, 2010, from ehiprimarycare.com: http://www.ehiprimarycare.com/news/5588/telehealth_%27to_take_off_by_2012%27
  • Telemedicine Reduced External Visits to Specialists . (1999). Retrieved March 12, 2010, from www.ncjrs.gov: http://www.ncjrs.gov/telemedicine/c2b.html (2009). In B. a. Weill, Information Technology for the Health Professions (p. 95). New Jersy: Pearson/Prentice Hall.

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